Provider Demographics
NPI:1831494574
Name:GLICKMAN, STEVEN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301-A WEST PALMETTO ROAD
Mailing Address - Street 2:SUITE 300-B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-338-5992
Mailing Address - Fax:561-338-6959
Practice Address - Street 1:7301-A WEST PALMETTO ROAD
Practice Address - Street 2:SUITE 300-B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-338-5992
Practice Address - Fax:561-338-6959
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist